Provider Demographics
NPI:1780788109
Name:NIEMIERA, MARK LEE (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LEE
Last Name:NIEMIERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:613 AMBOY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2577
Mailing Address - Country:US
Mailing Address - Phone:732-442-1441
Mailing Address - Fax:732-442-7684
Practice Address - Street 1:613 AMBOY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2577
Practice Address - Country:US
Practice Address - Phone:732-442-1441
Practice Address - Fax:732-442-7684
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MAO4370700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LS183OtherOXFORD
0K5093OtherHEALTHNET
NJ1905902-01Medicaid
77K03OtherEMPIRE HEALTHCARE
241137OtherUNITED HEALTHCARE
4094350OtherAETNA US HEALTHCARE
0105202000OtherAMERIHEALTH
10145OtherUNIVERSITY HEALTH PLAN
0997948OtherCIGNA
060022093OtherRAILROAD MEDICARE
13611OtherAMERIGROUP
455090OtherAMERIHEALTH
28022OtherLOCAL 825 FUND
37769OtherAETNA US HEALTHCARE
68713OtherGHI
13611OtherAMERIGROUP
455090OtherAMERIHEALTH